Provider Demographics
NPI:1841364080
Name:MOHAMED, HOSSAM
Entity type:Individual
Prefix:
First Name:HOSSAM
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E BUTTERFIELD RD STE 154
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5103
Mailing Address - Country:US
Mailing Address - Phone:630-800-3626
Mailing Address - Fax:630-261-0716
Practice Address - Street 1:951 OAK ST
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1579
Practice Address - Country:US
Practice Address - Phone:630-800-3626
Practice Address - Fax:630-261-0716
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1844001Medicare PIN